20130876 Ver 1_Complete File_20130816

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory e PRESS Thomas A. Reeder John E. Skvada, III
Governor Acting Director Secretary
AUG 16 2013
NC ®SNR DWQ Use Only: Project #
Express Stream Origin /Buffer Applicability Determination
Required Information
1. Owner Information (corporation /individual who is legally responsible for the property and its compliance)
1a. Name(s) on Recorded Deed
Seymour Johnson Air Force Base
1 b. Responsible Party (for LLC)
Robert Bero
1 c. Mailing Address
4 CES /CEPM 1095 Peterson Ave., Seymour Johnson AFB, NC 27531
1d. Telephone Number
(919) 722 -5579
1 le. Email Address
I Robert.bero @us.af.mil
2. Location of Project Site - please include the county, nearest named town and highway number:
Seymour Johnson Air Force Base, Goldsboro, NC, Wayne County. Near Highway 70. Project begins at intersection with
Guardian Road.
3. Has anyone from DWQ visited the site?
N
Staff Name
Unnamed Tributary of Neuse River
Date of Visit?
I Neuse River
Additional Requested Information
4. AgentlConsultant Information (if applicable)
4a. Name, Company
Stantec Consulting Services Inc.
4b. Mailing address
5565 Centerview Drive Suite #107
4c. Telephone no.
(919) 325 -4777
4d. Email address
[e-mail]
5. Project and Site Information
5a. Name of project
Repair Pavements Bldg 5003, 5005,
5006 & 5007
5b. County
Wayne
5c. Nearest Named Stream I
Unnamed Tributary of Neuse River
I 5d. River Basin
I Neuse River
5e. Provide a brief description of this project (attach site plan if available):
The project will repair and replace approximately 700 linear feet of a gravel /concrete /asphalt road with an asphalt road
and portions of the existing road will be widened to accommodate two -way traffic. Additional vehicle parking spaces
will be added.
Please attach a map of the site Indicating project boundaries on the USGS 1:24,000 Topo and/or NRCS Soil Survey.
If you are unable to locate either of these maps, please contact the Regional Office for assistance.
DWQ Use Only: Is this stream call for the purpose of: buffer mitigation _ nutrient offset credit
Please return form to: Roberto Scheller or Lyn Hardison
943 Washington Square Mall
Washington, NC 27889
Fax: [phone]
Email: Roberto.schelleroncdenr.gov,
Ivn. hardisohO.ncdenr.gov
Note: Submittals on Friday after 12:00 pm
will be stamped as received on the
next business day.
Please contact Roberto Schaller at (252) 946 -6481 if you have any questions.

Personal Account Information Redacted
Visitor Name
First: ROBERTO
Middle:
Last: SCHELLER
Base.
Issued:
Expires:
Sponsor
Name: Robert M. Bero
Phone: [phone]
Visitor Advisory - Conditions of Visit:
Visitor Pass
Permissions
PassID# 02663981
-Remarks
BLDG 5005
k \* �_kd�
1%1GYrFj A11
L
Approved Access Access Area FPCON
M 11:10 -13:00 Seymour Johns C Charlie
- Limit your movement to authorized traffic ways. Examples of
closed area signs: 'RESTRICTED AREA" or "CONTROLLED AREA"
- Observe Traffic Laws.
- Display Vehicle Pass on inside left corner of windshield while on base
(Motorcycles - stick on windshield or front fork frame) (Must be visible).
- Person issued pass is responsible for others in party and will keep pass
readily available to show proof of authorized visit by all.
- After visit, please dispose of pass as directed by security police.
Expiration Time: 08/19/2013 13:00
(Visitor Signature)
Visitor Vehicle Pass Pass 1D# 08144860
VCIIIG IC
Make:
Chevrolet
Model:
TRAILBLAZER
Year:
2006
Color:
White
Meri
WARNING - Consent to Search, Vehicle Towing,
Reimbursement, and Impeachment
- By accepting the pass you give your consent to search this vehicle
while it is entering, on, or leaving this institution. If your vehicle
is towed or impounded, you agree to reimburse the towing agent
on behalf of the vehicle owner /operator.
Visitor Name
Plate #: PK2055
Plate Country: United States
Plate State: North Carolina
- Occupant restraints must be used while operating the vehicle on
DoD property.
- A test of intoxication as assimilated by state motor vehicle law or statute.
(Visitor Signature)

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Name: SOUTHEAST GOLDSBORO Location: 035° 21'01.84" N 077° 56'58,43" W
Date: 8/20/2013 Caption: Seymour Johnson AFB
Scale: 1 inch equals 1000 feet
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